Tuberculosis in Children

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Defining various categories of tuberculosis in children:

A. Asymptomatic Mantoux Positivity: Implies that the patient has no tuberculous lesion and is only a tuberculin positivity.

B. Symptomatic Mantoux positive - Presence of fever, cough, loss of weight, chest infection not responsive to antibiotics with Mantoux positivity.

C. Pulmonary Primary Complex (PPC) - is suspected when the following criteria are met with

i) Essential criteria:

  • Symptoms of fever, cough, loss of weight, chest infection not responding to antibiotics.
  • X-ray lesion suggesting tuberculosis such as hilar adenopathy or parenchymal opacity.

ii) Supportive criteria:

  • Positive Mantoux test
  • Superficial lymphadenitis proven to be tuberculous etiology
  • Positive Family history of tuberculosis
  • Grade III or IV malnutrition
  • Non vaccination with BCG

D. Progressive Pulmonary Disease (PPD)- Progression of the PPC lesion is defined as progressive pulmonary disease (PPD) nodal lesions progressing to

  • Bronchial obstruction
  • Atelectasis
  • Bronchiectasis
  • Endobronchial tuberculosis
  • Spread to adjacent areas.

Paranchymal lesion may progress to

  • Lobar consolidation
  • Bronchopneumonia
  • Pleural effusion.

E. Disseminated/Miliary tuberculosis -
The term is used when more than one organ or non cotiquous body tissues are involved with tuberculosis. Miliary tuberculosis is a specific form of disseminated tuberculosis with classical radiological findings.

Presentation:

  • Acute with respiratory distress, weight loss fever etc
  • Cryptic type with no pulmonary findings,
  • presenting with hepatosplenomegaly, lymphadenopathy, meningitis, pleural, pericardial and other organ involvement.
  • Fundoscopy often reveals choroid tubercles.
  • Diagnosis:
  • Tuberculin often negative
  • Direct smear for AFB may be positive
  • Biopsy of the Bone marrow, liver, lymphnode, may reveal typical granulomas from which the AFB should be demonstrated.

F. Neurotuberculosis may be of several types -
  Meningitis
  Encephalopathy
  Serous TB meningitis
 Tuberculoma
 Radiculomyelitis

G. Others -
Abdominal tuberculosis
 Genitourinary tuberculosis
 Pericardial
 Osteoarticular tuberculosis

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KrishnanS 

Very simple, informative and good coverage of the topic.
Dr S krishnan
Apollo-Hyderabad

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